Archive for the 'NItty-Gritty' Category

Okay so my idea for a daily randomness of linkage didn’t really pan out. But some random health care and non-health care goodies:

Mythbusting Canadian Health Care, Parts One and Two. Brings up a number of good points I hadn’t considered before–doctors that spend less time with billing and financial headaches have more time to read and keep up with their specialty.

My Favorite Liar: Blogger recounts a trick an Econ professor would use to keep his students’ attention during lecture. Brilliant. One of my best lecturers I’ve ever had was Dr. Gil Chu, who taught our Molecular Bio course. His trick was incredibly effective: 10 questions had to be asked during class before we were allowed to leave, and he kept a tally on the board. It fostered a classroom where the assumption was that the material was hard, that we were moving fast, and that he probably wouldn’t explain everything perfectly the first time. And because students felt comfortable asking questions–you were contributing to the class being able to leave on time–people also asked things they were curious about. We were thinking!

Why Meth Is A Horrible, Horrible Drug. (Probably not safe for work.) A terribly sad video of a young woman, turned psychotic by the drug, from the A&E show “Intervention.” If you ever hear of a person running naked through the streets… they’re probably on meth.

And finally, Joe Paduda on HSAs, the rebuttal version. “One noted that they make “health care more affordable for the majority of consumers”; I think the commenter is conflating health insurance with health care. HSA plans may make insurance more affordable, but health care costs are not any cheaper under HSA plans. In fact, HSA plans’ higher out-of-pocket costs may make health care costs less affordable.”

Catron takes issue (“load of BS”) with my highlighting a recent poll showing support for single-payer over our current system, saying that the poll isn’t scientific and flawed. Well of course it is, Mr. Catron–all polls are. They also leave out all us young adults who have no home phone number and have unlisted cell phone numbers, too. Either never cite pollsor surveys yourself, or be honest. All polls suffer from selection and other biases. (Still, having half of respondents say they support a system where “all Americans would get their insurance from a single government plan” is pretty damn impressive to me. I never would have expected the number to be that high.)

Many companies are already paying for disease management programs to help patients with chronic diseases such as diabetes. So why not encourage people to take the medicines they need. You “pay a nurse $65 an hour to call call a diabetic [employee] and say, ‘Take a beta blocker.’ And the employee says ‘I know it’s important, why did you raise my copay from $15 to $30,” Fendrick says. “It’s a classic example of the misalignment of incentives in the U.S. health care system.”

45% of doctors who responded to a survey said they’ve given placebos to patients. That number certainly seems high, but sometimes patients don’t want to hear what you’re saying–namely, that no drug will help them. Giving antibiotics for a viral illness would almost count as a placebo, if they didn’t have the associated side effects and risks. I’ve certainly wanted to write for “Obecalp 1 tab PO BID” (‘placebo’ backwards) but I find it totally unethical and undermining of the doctor-patient trusting relationship. (Then again, patients don’t always seem so keen on the whole trusting relationship either, but that’s why we’re professionals.)

HIV and AIDS are back in the gay communitymy communityour communities. I just. Don’t. Get it. Sex without protection, drugs, ignorance. I saw a young man in the ED awhile back with multiple risk factors who I’m almost sure had acute HIV infection syndrome even though his rapid test was negative and I just wanted to shake him and cry at the same time. I still scratch my head and wonder if there’s a way to support those with the disease without normalizing it so much that it just becomes another chronic illness and not worth protecting oneself from and educating oneself about. Sigh. A California law just went into effect yesterday (I’m told) so that written consents are no longer required for HIV testing.

Interesting Journal Articles from Cases Blog, plus some tips on how to stay current with the journals. “How do you eat in elephant? In small bites.”

Found some interesting methodology in this article exploring alcohol usage interventions in the ED. (Heavy but non-alcoholic drinkers were found to have decreased their drinking at 3 months.) For everyone that qualified for the study, they asked them on a scale of 1-10 how ready they were to change some aspect of their drinking (10 being fully ready). But this score wasn’t really that important–it was to secretly get at the patient’s own underlying concerns about drinking, because here were the follow-up questions:

if 2 or higher, ask: “Why did you choose that number and not a lower one?”

if less than 2, ask pros and cons: a) Help me to understand what you enjoy about drinking? b) Now tell me what you enjoy less about drinking.

I love it. If you answer anything but 1, you’re indirectly acknowledging that there might be something less than optimal with your drinking. If you answer 1, you ask people to volunteer their own ideas about what’s good and bad about drinking. It’s essentially a sneaky way to plant discrepancy and cognitive dissonance in a patient’s mind.
Now of course, duh, this won’t work for everyone. Just thought it was a very clever way to force the patient to come up with his or her own ideas instead of casting that whole “You shouldn’t be drinking so much” light onto patients.

The “normal” body temperature, 98.6 degrees F has a fever, according to the LA Times. Turns out we base good ol’ 98.6 on experiments using mercury thermometers from the 1800s, and that depending on your race, age, gender, and time of day, your temperature is probably a couple tenths of a point lower than that. (Personally it would have been nice had the writer mentioned in the article that a person doesn’t have a fever until 100.4 degrees or higher, to do a little patient education out there in La La land.)

KevinMD and now the usually sensible Shadowfax continue to be wrong on teaching the business of medicine. (Don’t get my wrong, I completely agree these things should be taught, but it makes absolutely no sense to have the primary teaching be in med school.) Teaching it to pre-clinical students certainly makes no sense, they’re busy learning everything for Step 1. Teaching it to clinical students isn’t all that practical, as most are preparing for residency applications and wrapping up med school. (And my main point here: if you don’t use knowledge, you lose it. When will anyone but a senior resident be doing any sort of billing or admin stuff? You think an intern is going to retain knowledge of CPT codes? Perhaps if they’re in a continuity clinic or something–but then that’s something they should be learning on the job, in the clinic. Again, every single EM residency program I’ve seen so far has 2 weeks set aside for “Administration” in the final year, but honestly, if you all think it’s so important, residency programs could certainly find time for it. You could have it coupled with two weeks of X to make a 4 week block; you could have a morning lecture series for all the residents, or dedicate one noon conference every month or something to the topic. Med students are so far removed (remember, we’re not even DOCTORS yet)–what’s the point of filling our head with information that will just be quickly forgotten when it’s much more important for us to remember the possible side effects of ACE inhibitors we’re about to be pimped on?

Insurance does matter for cancer prevention, as Matthew runs through a recent study: “For all cancer sites combined, patients who were uninsured were 1.6 times as likely to die in five years as those with private insurance.” This is sadly one of those “duh” studies that has to be done anyway, because of well-insured, financially-secure naysayers who somehow believe their situations are no different from people without insurance.

Ignore those calorie burning meters at the gym. There’s almost nothing more inaccurate in the fitness/weight-loss/exercise world. I’d previously heard the eliptical machines overestimate by 20%, but this article claims they’re just plain wrong. Break a sweat (after approval from your doctor, Mr. Quintuple Bypass with Chest Pain at Rest), and exert more than you take in. 1 pound = 3500 Calories. 500 less Calories a day = 1 pound of weight loss a week. Slow and steady wins the race.

Trying out a new feature here at Over My Med Body. Short little commentaries on links, a la KevinMD, as there’s tons of great blog posts and health policy news, and so little time to discuss them! (Also, this will be more productive than watching The People’s Court and Montel.)

Dr. Wes pimps med students interviewing for residency on billing codes, and Kevin (I hope jokingly) says med students should have to get an MBA before starting med school. How silly. The point of med school (which most of the commenters point out) is to give you a foundation of knowledge to learn how to practice medicine, get exposed to all the medical specialties, and prepare you for internship. It’s residency that should be teaching doctors about how to be an attending. (All the residency programs I’ve seen so far have a specific “Administration” component to them where you learn about billing and getting paid.) Wes says med students “are woefully unprepared to enter the big wide world of medicine,” but if there’s some way to enter medicine without doing a residency, I missed that day in class.

Via KevinMD, this great quote about the two sides of medicine we’re trying to turn into one: “Today, we are in between two images of the doctor. One image is the heroic personal savior, who uses his own experience and intimate knowledge of the patient to make the best decisions. The other image is the trained technician, who gathers data, feeds it into a decision tree, and implements that recommended course of action.” Totally agree. The best is the caring, experienced doctor who knows the data, when to use it–and when not to.

College is not the time that many young women want to get pregnant, but Congress isn’t making that any easier, closing a provision that allowed drug companies to sell cheap birth control to student health centers. A monthly supply used to be $3-$10, now it’s $30-$50. Some members of Congress are aware of the issue, but can’t get it fixed, since birth control pills are so closely tied to abortion (that’s sarcasm). It’s amazing to me that tiny little oversights can have such huge impacts on people’s lives.

Speaking of bad daytime television, I saw this quack tell a poor woman suffering from pretty classic hypnopompic sleep paralysis that she was just doing “astral projection.” The poor lady was scared out of her mind, thinking the devil was visiting her.

This pilot program at UCLA sounds pretty awesome–bilingual docs who train in Spanish-speaking countries get help preparing for US board exams in exchange for 3 years working in under-served areas in California. More surprising in the article is the claim that only 8 of the 27 family medicine residents at the highlighted residency speak Spanish. (I’d imagine all of them can at least speak basic Spanish.) But I agree–there are certainly nuances that you lose only speaking basic Spanish, and cultural nuances that affect what a person is saying.